| NPI | 1851348163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: PA TE002999L) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: DE J2-0000608) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2007-07-08 |